Provider Demographics
NPI:1164489191
Name:GARDO, O BOYD JR (ANAPLASTOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:O
Middle Name:BOYD
Last Name:GARDO
Suffix:JR
Gender:M
Credentials:ANAPLASTOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:126 COOL MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-8941
Mailing Address - Country:US
Mailing Address - Phone:864-226-3006
Mailing Address - Fax:864-845-5034
Practice Address - Street 1:803 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5707
Practice Address - Country:US
Practice Address - Phone:864-226-3006
Practice Address - Fax:864-845-5034
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2711Medicaid
SCDE2711Medicaid